Indications and candidacy for active middle ear implants

Currently, there are two active middle ear implants available commercially: the Vibrant Soundbridge system and the Carina system. A third active middle ear implant, the Esteem, is under clinical evaluation. All devices are indicated for patients with moderate-to-severe hearing loss. Because active middle ear implants are directly coupled to middle ear structures, many of the problems that patients with conventional hearing aids report, such as acoustic feedback, occlusion, and irritation of the outer ear canal, are avoided. In addition, AMEI patients perform well in background noise. However, indications for AMEIs are selective and candidates should be carefully evaluated before surgery. Before considering an AMEI, patients should be provided with conventional hearing aids. Only when benefit is insufficient and audiological selection criteria are met is further candidacy evaluation indicated. Since Colletti described coupling the Vibrant Soundbridge directly onto the round window membrane in 2006, the indications for the Vibrant Soundbridge have expanded and the VSB is implanted in patients with conductive and mixed hearing losses. Patients have often undergone middle ear surgery before. Especially mixed hearing loss cases with 30-60 dB HL sensorineural hearing impairment and 30-40 dB HL air-bone gaps may be helped by this new application.